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Special scenarios in the management of central nervous system aspergillosis: a case series and review of literature
  1. Sucharita Ray,
  2. Neeraj Balaini,
  3. Kamalesh Chakravarty,
  4. Shivnarayan Pattanayak,
  5. Abeer Goel,
  6. Aastha Takkar,
  7. Vivek Lal
  1. Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Kamalesh Chakravarty, Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; drkamalesh70{at}


Aspergillus is a rare but important opportunistic pathogen to invade the central nervous system (CNS). It is a significant pathogen of not only immunocompromised but also immunocompetent patients. Its manifestations are pleiotropic, reflecting multiple mechanisms of pathogenesis and host interactions. Despite significant advances in diagnostic methods and therapeutic options, the mortality remains high. Several advances have been made in medications and surgical management, yet, current treatment practices lack uniformity. Patient woes are further heightened by the high costs of treatment and prolonged duration of therapy. In view of the challenging aspects of this disease, we present a short review of four challenging cases touching on the varied aspects of management of CNS aspergillosis covering pathogenesis, diagnostic pitfalls, surgical and medical options and evidence-based guidelines for the management of the same.

  • aspergillosis
  • rhinocerebral
  • CNS aspergillosis
  • antifungal
  • voriconazole
  • amphotericin
  • debulking surgery
  • debridement
  • pathogen
  • nitrogen cycling
  • epitope
  • pathogenesis

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  • Contributors VL, SR planned the project, SR and AT conducted literature search and compiled the cases, NB, SP and AG collected the data, images and followed up with patients for latest update on their illness. SR and NB wrote the manuscript and submitted the project. KC was involved in conceptualisation of the paper. NB and KC were involved in the editing of the paper. Final submission was done by KC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.